Main menu

Category Archives: arthritis

Most of you know that I am an avid runner. Well, maybe not so much since my hip replacement a little over a year ago. Since my 1 year checkup showed that my implant has been incorporated into my skeleton I have given myself a license to return to my addiction. Kind of.

I went for a 4 miler yesterday and did something I haven’t done in at least 5 years. I didn’t use a running app on my iPhone to track my mileage and time. Sure, I took my phone because having that lifeline is good, just in case. And pictures. I like to take pictures.

What has changed?

A few things. While recovering, maybe regenerating is a better word, from the surgery I started to read about the human body. I bounced around among tomes on evolution and fitness. As I read more, I started to focus in on a couple of areas – biomechanics and anatomy . NOTE: The links I just provided are a sampling of what is written and represent my gateway reading. There are many other books and articles. I encourage you to read all you can.

As my recovery continued I found myself looking for a job. That process, which is worth its own post or two, took several months and occupied a lot of my time. There was a guilt paradox going on. I had the “free” time to do more cycling and running but felt guilty if I wasn’t pursuing a job with that time. When I did find a job (a great one that has been very much what I hoped for) I committed to a long commute that kind of puts a twist on my typical morning workouts. I’m still adjusting to the timing.

All I’m saying is that my ramp up to distance has been slower than it would have been a year ago. And that has turned out to be a good thing. Since I couldn’t run, I read about it, and I found alternate forms of exercise. All of that informed my running going forward.

As a writer, I decided to start a book about what I’ve learned and to distill that learning into something readable and prescriptive. In taking my own medicine, I’ve re-thought how I run. Not my form, but my pace and mindset.

I used to run to a clock and work on specific workouts. Statistics embraced me at the end of each run and were automatically uploaded to social media. I loved it because I got in contact with other runners, many of whom have become friends beyond the running. All of it reinforced my process. Was I addicted to running or to the tracking of my running.

Admittedly, I am not fast. I’m average or a little better, but I will never win a distance race. Period. Why was I working on speeding up my running? Did I really enjoy that?

On a run one weekend I was thinking about running. It was only 3 miles, but for my point in recovery, that was my goal. I looked around and started to play a little as I ran. On a wintery, Sunday morning in the New England town in which I live, the roads are quiet and the woods are stark and graphic. Sections of snow and ice make force you to pay attention, and I ran out into the road to avoid some of the obstacles. Then I started to run out and around in the road just for fun, like a kid pretending to be an airplane or stepping around some obstacle course. I smiled without thinking about it.

The run became fun. I’ve always enjoyed running, but this was a different kind of enjoyment. I still had my iPhone app running, but I was having too much of a good time going down some side roads I hadn’t traversed and stopping once in a while to hear a woodpecker hammering on an oak tree. That sounds carries on a cold, brisk morning.

Yesterday, taking advantage of a warm spell, I went out and followed my instincts. Although I didn’t run on a trail, I am able to use the margins of our country roads to good effect. My neighbors don’t seem to mind me running on the edges of their lawns. As you can see, that area is usually offered up to the gods of snow plowing anyway, so I’m not doing much damage.

I continue to use a natural style of running, meaning it stems from a barefoot mode of movement that prevents overstriding and encourages a forefoot to midfoot landing. What I have found is that it isn’t about how your foot lands, it is about not overstriding. In other words, your foot should not extend out beyond your knee when you step forward. The only way to do that is to keep a bend in your knee, which eliminates heavy heel striking. You can still heel strike, but without an overstride, you significantly reduce the impact.

That said, I do wear shoes. What I wear are have a low lift – only 4mm – and a nice wide toebox.

These are Saucony’s and besides the low cushion, low lift they have a cool color. Why shoes? Well, the side of the road is not a prestine trail. There are many interesting deposits which are the outcome of human activity.

The shards of glass are pretty common. The computer remnant was a bit unique, but there is always something. True, you hardcore barefooters will rightfully say that over time my skin will thicken and these things won’t matter. I started down that path and found that shoes don’t hurt in pursuit of good form. Sorry. Plus, I can take a running break at Starbucks and not have worry about putting on those gauze booty things.

More important, I gave myself permission to not worry about time or distance. Just run and enjoy the motion. Those times when I felt the pace going up, I slowed myself down to where I was breathing normal and not huffing too much.

What’s it matter?

Slower, means better form. Better form means less injury. I’ll post more about that sometime, but not right now.

This is about enjoyment of an activity I have done the majority of my life. I’m in it for the long run, so to speak. I already admitted that I’m not fast and my 3hour, 37minute and change Hartford Marathon is going to be my best. I managed a sub 47 minute 10k, too. That was my best at that distance. I’m okay with those times. Clearly, I’m not setting any records and improvement means taking a “work” perspective to running. That’s not my mode anymore. I’m running untethered.

What I’ve learned is running is about finding your pace and enjoying motion.

Very few things are average when it comes to people. Let’s start with the basic question: How do you measure a person? Height? Weight? BMI? Years of education? Income? Age? How many pushups they can do? How often they have sex?

I don’t want to ruin my reputation as a writer, but I did a lot of math and statistics in college. The first thing I learned is respect for the numbers. The second thing I learned is that with the right perspective, the numbers can be made to represent lots of things. It is a statistical thing. How you measure determines your results. In graduate school I did a really interesting (Hey! It was for me.) thesis that used all kinds of statistical machinations to see if my hypothesis was true. I won’t get into the gory details, but I will say that along the way I had to make decisions on how and what to measure. I was able to find all kinds of research justifying how I did it. I’d be fooling you and myself if I didn’t think I could have found the same amount of research to justify a totally different approach. And that was before the world wide web and Google and wikipedia. I had to use a real library and keypunch my statistical analysis onto Hollerith cards and batch run them in a thing called a mainframe.

Melancholy over numbers taught me one thing; I could measure an entire population, calculate the mean (that is the statistician’s word for ‘average’) and find that no specific sample equals the mean. It happens all the time. So why does average matter? For manufacturing I think these kind of statistics are priceless, but for people? I’m not convinced. Sorry Dr. Oz, psychology and the weight loss industry, but I think you have it all wrong. We don’t exist on a normal density function (normal curve, bell curve, whatever). Only the measurements do.

If I look at my height (5’5″) I am in the negative side of this normal curve. But, if I look at the number of men over 50 who have run at least 3 full marathons, written several books, have a graduate degree, most of their natural hair, a US patent, and a hip replacement, I think I’d be on the very end of that long, positive tail.

Like everyone else, I exist on many curves. The average of me is the sum of many measures, many of which are not normal. And I am okay with that.

By blurring reality with summary statistics, analysts are missing the micro-trends of normal. Normal is context driven and very subjective since there is no such thing as objective perception. Sorry Ayn Rand. Objectivism belongs in fiction, not in reality. Normal is a blend of traits, attributes and myriad other characteristics that make each of us different.

Why is this important?

It demands a change in perspective. We focus on all the wrong things when we equate average with desirable. Think about body style, food consumption, exercise, and don’t even get me started on how fucked up our educational system is because we quantify all the wrong things and then apply them to our children.

What is normal?

As I am often willing to do, let’s take it back a few million years. Back when we were developing as humans and became the greatest hunters on this planet. The only animal that has learned to survive in all areas of the planet – well, except for cockroaches.

We didn’t understand statistics while we evolved. (Yes, evolution is a fact.) What we understood was that every person could contribute. I am assuming that unless you were a liability to the pre-history man, you were considered a positive resource to have. That meant that the range of acceptable characteristics was measured by contribution, not focus on a specific attribute. I say that because survival was about getting enough calories to sustain while we had sex to procreate, which led to the need for more calories. During that 2 million year period of pre-civilization our DNA got wired in. We learned to dream because we learned to track animals. Successful tracking meant we had to project our minds into the animal we were tracking to understand where they would go when we lost the trail.

Zip forward to today. (Sorry for the whiplash.) I am seeing people beginning to fight against that averaging of expectations. In some cases they are fighting at the outer edges of the curve (#StigmaFighters) in other areas they are fighting in the middle of the mix (Virgin Industries and other employers who focus on people). There are men and women I know who have found new strength in accepting who they are and then building on it in a positive way. Some lift weights that are heavier than me, others craft words that melt my mind, and others move across the world with fleet feet and strong hearts, touching the essence of what made man dominant – distance running.

You homework is to find one trait you are most average about and one that you are least average about. First, humor yourself that you are the product of 3 million years of evolution. Then have a beer. Then be proud of being just an average guy (gal). Then celebrate not being normal.

I have been a personal advocate of staying fit for a long time. At least the last 40 years. This past week that advocacy paid off. A large reason for my speedy recovery from the hip replacement surgery has been my fitness. A 40 plus year pursuit of fitness has given me two benefits in making the recovery happen.

Let me be clear. I consider myself to be pretty much an average guy. I am not fast, big, or strong like professional athletes. I place pretty well for my age group in races that I have done and I’ve always been able to improve my performance or not have it deteriorate over time. I am proof that you don’t have to be a world class athlete to stay fit and have fun doing it. One indicator is that my weight really hasn’t changed much in the last 25 years. I still wear the same jeans I had from the mid-90s.

What I Had to Get Over

It might seem prideful, but I’ve always been very healthy and I attested that more to a consistent workout lifestyle than to any particular eating program. Whether it was running, tennis, racketball, cycling, or lifting, I was active all year round. I was never a musclehead, but weights of some sort have always been part of the routine to compliment the other activities.

Having to go in for hip replacement made me seem like a failure. All that work and effort and my body still failed me. Going into the surgery I did a lot of reading and talking to people who had replacement work done themselves. It was a consistent message that this surgery had a high degree of success and people returned to near normal activity levels. That improved my expectations and attitude, but the sense of failure still lingered.

In retrospect, there are a number of things I would have done to hold off the onslaught of arthritis. Most of all I would have focused a lot more on my running form, not just running exercises to get faster or build endurance. Unfortunately, there are few materials that really talk about running form from a true biomechanical perspective. I have found one that is proven, but that is for a future post.

My Post Surgery Realization

Now that I am 1 week and 4 days post surgery and my recovery consistently gets called a “model” by the physical therapists and doctors, I realize that my level of fitness had two benefits.

First, it was a lot easier for the orthopedic surgeon to do his job. My legs are fairly lean and the muscles are fit from cycling a lot lately. It made it easier for him to get to the joint and to do the work. I was told a little about how much manipulation you go through when they test the joint. It is not something I want to find on YouTube, although I am sure I could find it.

His incisions are clean and not showing any indication of infection or leakage and I can tell they are healing well. A fit metabolism comes with the general fitness. It is a body used to recovery from some trauma. I needed some pain meds to get through those first few days, but even that requirement has eased off quite a bit. I’m on to Tylenol a few times a day and one pain killer before bed to make for a better rest.

The second benefit has been in the process of physical therapy. I’ve got a good base to work from, but I am also used to the process of doing sets of exercises and keeping good form while doing repetitive motion. I expect the burn to happen when I push the edge and know how to breath to keep relaxed while putting in the effort. It is just a natural thing for me. The therapy progresses faster if you push it to the limit, but not much further. You can’t overstrain, but you need to work it.

Again, I’m not that unusual. I just have a habit that seems to be paying off.

The Fear Is Gone

I mentioned the fear of surgery in the last blog. It is normal. I really was not looking forward to being cut open. Now that it is all done I am looking forward to continued recovery and rediscovering different activities. Yes, I plan on running again and I will focus on the Pose Method of running. I will also start building the mileage on my bicycle, increase plyometrics and even getting into swimming. All that and just playing around like a kid. We all need to be kids.

All of this has led me to start reading a lot about biomechanics of the human body. It is a fascinating subject and I hope it will inform my active lifestyle in the future.

If this helps any of you to rekindle your desire to get in shape, then I am happy. Take your time. Find your limits. Give your body the recovery it needs, but be consistent and always push a little more.

On Tuesday morning around 8:30am a female anesthesiologist getting ready to administer a spinal block said to me that I would feel a little pinch. I was sitting up resting against something akin to a massage chair. The second anesthesiologist had put a plastic mask over my mouth and nose and was feeding me oxygen. Several other members of the surgical team were off to the side preparing the computerized arm that would assist the surgeon in my total hip replacement. I was expecting the anesthesiologist to say “You’ll start feeling a little sleepy,” but that didn’t happen. Actually, nothing happened. In one split second I was wondering when they were going to put me under and in the next I was in recovery with a nurse rubbing my hand and arm asking me how I was doing. About 4 hours had passed and I was now bionic. An average guy turned into a potential superhero. Don’t get excited. I still haven’t figured out my super power, although it might be recovery from major surgery.

I did experience the one thing that I was dreading most – catheterization. I’ve had fantasies of nurses fondling my manhood, but this wasn’t one of them. Any man reading this will momentarily cringe at the thought of a rod being inserted in their member. It is just not a natural thing and something we are genetically taught to protect ourselves from. Then there is always the weird fear you have about the nurse being pretty and worrying if you will have a manly reaction to her touch. Well, don’t worry. That kind of thought is the furthest from you mind. With multiple layers of discomfort engaged, she used a confident hand and administered to catheter which, much to my dismay, wasn’t a painful as I thought it would be. It did feel good to get my bladder relieved.

When my room was ready I made the trip up to the 12th floor and got wheeled into my room. Then began the first of a repeated process of blood pressure, oxygen, pulse, temperature and going through the identification checks. And the meds. The meds were multiple pills, the best being those light narcotics that made the pain be fuzzy in the background.

I wiggled my toes for anyone who walked into the room like a second grader who had learned his first song on a violin. Feeling warm and cozy I figured I would settle in for a long nap and wake up in 2 days to go home.

Then it happened.

Her name was Stacy and she was the physical therapist. Hidden behind that cheerful smile, dark hair and pretty face was an evil demon. Well, that’s what I thought when she said “We’re going to get you up and walk for a while.”

Here’s where those many years of going out to run or being at mile 20 of a marathon and wondering WTF paid off. I didn’t protest or grumble. I knew this was where the rubber met the road and with the first step out of the bed I was going to set the tone for my recovery. Getting well is like going into training. There is a program and you have to follow it. Stacy was great and showed me the right way to get out of bed without twisting things. She also made me do it myself after she showed me.

I used a walker to go from my bed over to the door and back. That was all I was going to do on the surgery day. That small journey was about all I could take. She said it was also very good for right after surgery. They’d be back for more later.

I was in and out of drug and pain induced sleep. Teri got there just after my PT and stayed with me until it was dark and she had to go to get to the grocery store before it closed. I was not great company, but just having her next to me was all I could ask for.

Day One Post Op

I won’t bore you with the repetition of pokes and prods except that I was very consistent in my blood pressure (115/65 on average) and heart rate (62bpm). My pain level never really got above what I characterized as a 4 on a 10 scale and the basic pain meds were taking care of it. That felt really good. I wasn’t trying to be a manly man and suck it up. If my pain went high, I wanted them to know because it meant something. Plus, a body in pain is not focused on healing, but on prevention. For a short time and in the right amount pain medication is a great curative.

The main program each day was my PT and my occupational therapy. That and mastering peeing in a bottle while lying down in bed. Not as easy as you think.

I got a toweling off and clean surgical pants from the OT. Even got into the clean T-shirt I brought. I was beyond being self conscious that I was commando style under my garments. Getting comfortable trumped most everything else.

On the morning PT I managed to steer the walker on one round of the 12th floor. That wore me out. I tried to read but my brain could not engage. I learned that daytime TV is totally worthless and repetitious. There are women discussion panels, hollywood watchers, stars who want to be psychologists, psychologists who want to be stars, and judges.

I was thankful for the sleep induction from the drugs.

When the second round of PT came time I was grateful for the escape. We started down the hall but this time we turned into the PT Gym. There I did some leg exercises (more on that in a future post) and climbed stairs. One day after surgery and I was climbing stairs. I even impressed myself.

Day Two Post Op

PT was there first thing. At 7:30am Stacy and I were rambling down the hallway in the walker and I was moving with a lot more flexibility, even though it was still very still stiff. In the gym I completed four rounds of stairs and Stacy handed me my cane. “This is yours to keep.” She set it up and I walked around the gym getting used to the rhythm of the movement.

I decided I would leave the walker and go with the cane. She said I could now move around freely and that she would warn the nurses so they wouldn’t try to tackle me. When we got back to the room she set me up in a chair, not the bed, and showed me how to get up and down and what not to do. She told me I should get up frequently but that was an unneeded instruction. I felt glorious with independence. No one was going to stop me now. I could pee in a toilet. I was a big boy again!

With OT I learned how to put on my clothes and got to use this sock thing. I was skeptical at first, but it is a very cool way to put on socks when you can’t bend over. Being able to do that was the icing on the cake of me feeling independent.

Day Three Post Op

I was going home today. Early PT and visits from all the doctors and head nurses to make sure everything was in order. I had been moving a round with a cane with great ease and changed myself into my street clothes with great satisfaction. Dr.Gupta came for one last hospital visit and we covered all the details. After he left I recounted that I had gotten all of the “wants” in my new hip that I had listed. It was ceramic on plastic, done with computer assisted technology and the stem that will allow the bone to grow in (the option is to have the stem cemented in).

I got home and had a wonderful reunion with the family. They held off Thanksgiving dinner until the day I got home (Friday) and by the end of the day I was only using the cane to help me keep balance on the stairs and outside. We all stayed up late and had pumpkin and apple pie and laughed about things in general.

Today is day four, I am pretty much walking unassisted. I showered this morning and feel refreshed and nearly normal. It was much easier getting in and out of bed last night and this morning than at any other time since the operation. Basically, the recovery continues and much faster than I had expected.

I don’t have any biological reason that my recovery has been so good. I am an average guy except that I am now bionic. The only differentiator between myself and the other patients I saw on the floor who had undergone similar surgeries is that I am in shape. Not as good as I have been in the past, since I am up about 5 pounds, but I was still riding my bike and doing yoga up to the day before the surgery. To me, the reason for the recovery is that I believe in running and the power that doing it well will give an individual. And keeping a smile on your face. It is hard not to recover when you are smiling.

I can’t end this without extending my thanks to all the the nurses and nursing aids who tended to me over the three days I was under their care. I was subjected to a constant barrage of smiles and good nature and, most important, true caring for my wellbeing. each time they touched me for a pulse or to feel my skin temperature they were healing me. It is a gift that I am grateful they share.

Belated Happy Thanksgiving to all of you. As I remind myself each morning when there is that twinge of pain – “Persevere and be of good cheer.” It was an admonition from a professor I had in graduate school, but one that seems appropriate right now.